Great Expectations continued...

"We have known for many, many years that these antidepressants don't have the kinds of response rates in the real world of practice that they have in those clinical trials that are funded by industry or by the government," Mischoulon says.

He notes that in industry-funded studies, "patients are selected very carefully. For example, they don't accept patients that have certain co-existing illnesses or other health problems or other factors that might rule them out," Mischoulon says.

"That doesn't reflect how practice works in the real world. In other words, if I have a patient coming to see me because they have depression, I'm not going to say, ‘Well sir, I'm not going to treat you because you also have diabetes.' That's not how we practice. The fact is, the more comorbidity [co-existing disease] there is, the less likely people are to get well when they're depressed. Depression and medical illnesses and other psychiatric illnesses all interact with each other. For me to see these meta-analyses that show that antidepressants aren't that fantastic, well, this is what I've been observing for years in my practice and so have most of my colleagues," Mischoulon says.

"Even our best antidepressants work only about half the time," Payne says. And the odds of success drop if the patient doesn't respond to the first drug they try, Payne says.